Susan Michie, Director of the Centre for Behaviour Change at University College London, explains why it is never easy to make healthy changes to our lives, how it can still be done nonetheless – and why she used to only wash her hair in the gym.
Interview: Dietmar Schobel
HEALTHY EUROPE
Most of us are well aware of the importance of having a balanced diet and taking regular exercise. So why is it so difficult for us to put this into practice?
Susan Michie: One tried-and-trusted concept for describing the essence of why people behave is the “COM-B model of behaviour”. This stands for Capability, Opportunity and Motivation. All three elements are needed for a specific behaviour to occur, and we must have the mental and physical ability to carry out this behaviour. A suitable physical and social environment must exist as well. And we must be motivated to show this exact behaviour rather than other possible behaviours. A distinction is made between “reflective” and “automatic” motivation. “Reflective” refers to our considered intentions and evaluations, “automatic” to our desires, emotions and habits.
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Can you give a few practical examples?
Susan Michie: Imagine you wanted to eat more plant-based products, which entails eating vegetarian meals more frequently. On a capability level, this means knowing what and how to cook plant-based ingredients (knowing a suitable recipe and being able to cook vegetarian food). On an opportunity level, you need to have the time and the necessary ingredients. And on a motivation level it means that you want to cook and eat vegetarian food, for example, for health reasons. Protecting the climate can also be a motivation, given that growing plant-based products is known to produce fewer CO2 emissions than raising livestock.
Most of us try to do too much in too short a time.
SUSAN MICHIE, DIRECTOR OF THE CENTRE FOR BEHAVIOUR CHANGE AT UNIVERSITY COLLEGE LONDON
HEALTHY EUROPE
Healthier living is a popular New Year’s resolution, but one that often falls by the wayside before the first week or two is out. What can people do at an individual level to increase their motivation?
Susan Michie: Most of us try to do too much in too short a time and give up when we don’t reach our goals. Two important lessons here – begin with small, realistic goals and build on success, and be persistent if at first we don’t succeed. Thinking about why we weren’t successful and brainstorming ideas for making it easier, either by ourselves or with another, is important for learning about oneself and what is likely to work. An example of a goal that is too high might be changing one’s diet with the aim of losing half a kilogram (just over a pound) every week. This is setting the bar very high. Losing half a kilogram every month is enough – and having a food plan and keeping a food diary can help you keep track of your progress towards your long-term goal of weight loss.
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Are there certain techniques that can help us to live more healthily?
Susan Michie: Our behaviour is often prompted by a specific situation, at a specific point in time and in a specific place. One technique that uses this is “Mental Contrasting Implementation Intention” which has four steps. The first one is to set a realistic goal. The second is to imagine the agreeable benefits of reaching this goal. It is not until the third step that we should visualise the obstacles in our way. Finally, the fourth step involves developing a plan to overcome these obstacles and reach the goal. Specific plans are more likely to be effective. In psychology, we refer to the “intention behaviour gap” and specific plans are likely to close it, as rewarding yourself can help to reinforce this positive behaviour. I used this when I was setting up a routine for myself of going twice a week to the gym. My plan, and rule was that I could only wash my hair in the gym. Having clean hair was a sufficient motivator to get me going regularly, and once the pattern was established, I no longer needed to link it to hair washing.
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What can be done at societal level to encourage people to embrace a healthier lifestyle?
Susan Michie: Steps can be taken addressing every component of the COM-B model. With regard to capability, for instance, this can be done by increasing health literacy. Training courses allow people to learn how to collect, understand, evaluate and apply health information more effectively. Or organisations could make a point of communicating health information as simply and accessibly as possible. One example of increasing opportunity is to provide sufficient bicycle lanes so that people can engage in the healthy activity of cycling without fearing for their safety. There are also many possibilities on a motivational level. Interventions seeking to change motivation include taxing unhealthy products and subsidising healthy ones. Successful interventions can be deployed at various levels. One prime example is the national programme for reducing the number of smokers in the United Kingdom. This includes levying higher duties on tobacco products, placing anti-smoking advertisements and offering free courses to help people give up smoking.
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Is it easy to change behaviour towards an ideal?
Susan Michie: Change is never easy. If it were easy, people like me wouldn’t have a job. First of all, it’s about understanding the reasons why people have unhealthy lifestyles – and making healthier behaviour as attractive as possible. As I mentioned before, it’s also advisable to approach this on multiple levels and to tailor the measures and media channels to the target group in question. For instance, young people tend not to give too much thought to health questions because health is something they take for granted and something that tends to become problematic mainly in later life. Ecological arguments are often better than health arguments for motivating this particular target group to lead a healthier lifestyle.
If change were easy, people like me wouldn’t have a job.
SUSAN MICHIE, DIRECTOR OF THE CENTRE FOR BEHAVIOUR CHANGE AT UNIVERSITY COLLEGE LONDON
HEALTHY EUROPE
What is the best strategic approach for achieving noticeable improvements in the health of the general population?
Susan Michie: At the Centre for Behaviour Change based at University College London, we have produced many evidence-based guides, books and other publications and developed training courses aimed at researchers, practitioners and policymakers at local, regional and national levels. The Behaviour Change Wheel framework is a tool that was created to help understand behaviour in its context and also develop interventions on the basis of this understanding that are likely to be effective. It was conceived as a synthesis of 19 behaviour change frameworks, many of which were partial and overlapping. With the COM-B model as its hub, it describes in a practical and systematic way where and how to use interventions that aim to bring about a healthier lifestyle. You can read more about this in the book “The Behaviour Change Wheel: A Guide to Designing Interventions”.
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Are the strategies for encouraging more environmentally conscious behaviour among the general public the same as those promoting a healthier lifestyle?
Susan Michie: Essentially, yes, but health risks such as those presented by the COVID-19 pandemic are experienced far more directly than the effects of climate change, which still seem to be a long way off for most people. However, images can be a good way to inform people of the dangers of climate change – for example pictures of floods and fires in places not too far or dissimilar to where they live, and environmental pollution caused by plastic waste.
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What is the best way to convince people of the need to get vaccinated against SARS-CoV-2 infections?
Susan Michie: There are no quick fixes for this either. If, for example, people do not want to get vaccinated for religious or cultural reasons, we need to respect this. However, it can be very helpful to have testimonials from opinion leaders in ethnic or religious communities who lead by example. People may not get vaccinated for practical reasons – for example because they don’t have the time or the opportunity or financial compensation for attending clinics or taking time off if they have side-effects; this can and should be addressed through practical measures.
Susan Michie is Professor of Health Psychology and Director of the Centre for Behaviour Change at University College London, United Kingdom. She served as an expert advisor on the UK’s Scientific Pandemic Insights Group on Behavioural Science (COVID-19) and the Lancet’s COVID-19 Commission, and is also a member of the UK’s Independent SAGE. This is a group of 19 scientists who are providing independent scientific advice, with weekly public broadcasts, on how to minimise transmission, and hence long COVID-19 and deaths, support Britain’s recovery from the COVID-19 crisis and increase preparedness for the future.